Wound drain catheters for draining closed wounds generally comprise a drain portion in fluid communication with a wound and an outflow tube for transporting fluid from the drain to a reservoir. Typically, the outflow tube is connected to a vacuum source after the drain has been placed in the wound and the wound has been closed. The most common type of wound drain catheter is a tubing perforated with spaced apertures through the tubing wall. The spaced apertures are usually in opposed pairs and the spacing between the aperture pairs may vary. A significant problem with wound drain catheters is that wound debris, such as clots, may block the apertures thereby reducing the effectiveness of the drain. Another problem is that as the wound heals, tissue tends to form in the apertures of the wound drain catheter further reducing the effectiveness of the drain. In addition, when the wound drain catheter is removed from the patient, such as by applying a pulling force, any tissue that has grown into the apertures will be torn from the patient's body causing discomfort and retarding the healing process. If tissue growth into the apertures is extensive, the drain may break during removal thereby leaving a portion of the drain in the patient's body requiring additional surgery.
Other wound drain catheters have flat or round elongated channel shapes with a solid core, however, these channels tend to easily collapse. Furthermore, when these drain catheters are removed such as by pulling, the diameter of the catheter decreases and gaps between channels causes pinching thereby trapping tissue during drain removal.
Wound drain catheters generally have a flexible drain portion and a flexible outflow tube portion. The drain portion is integral or attached to the outflow portion. The drain portion is placed in or adjacent the wound site and the outflow portion will pass through the skin of the patient and be connected to a source of vacuum to drain the wound site.
Trocars are commonly used to insert wound drainage catheters or tubing into a drainage site adjacent a surgical wound or from a surgical wound site through the skin of a patient. These trocars usually have the tubing attached to the one end of the trocar so that the tubing follows the trocar along a path through the patient's body. The trocars are usually made of surgical grade stainless steel or other materials so that they may be sharpened to a very fine point to allow the distal end (end farthest from the point of origin) or sharpened end of the trocar to pass through the body tissue. There is generally a slight bend, about 15 degrees, in the trocar to allow the trocar to be manipulated through the body of the patient to correctly position the wound drainage tubing in the position desired by the surgeon. In many instances, it is difficult to properly position the wound drainage tubing because it is difficult to pass the trocar through the patient's body without hitting a solid structure such as bone.
Several techniques may be used to insert a wound drain catheter in the patient's body. For example, a surgeon may simply place the drain portion and a small part of the outflow tube portion in the wound, close the incision, and suture around the outflow tube portion. This technique is somewhat unsatisfactory, since it is difficult to completely seal the area around the outflow tube by suturing, and thus, the wound may become infected. A more satisfactory technique is to pass a trocar, preattached to the end of the outflow tube, through healthy tissue by entering the patient's body at a point within the wound and exiting at a point adjacent to the wound. The surgeon pulls the trocar with the outflow tube portion through the tissue until the catheter is properly positioned, with the drain in the wound. Since the outflow tube exits the body at a point adjacent the wound, the wound can be completely closed by suturing, thereby reducing the risk of infection.
U.S. Pat. No. 3,136,316 (Beall) discloses a catheter comprising a tubular body having a longitudinally extending passage. A distal marginal end of the tubular body has at least two longitudinally extending grooves. At least one aperture provides communication between the passage and each of the longitudinal grooves. At least two longitudinally extending rows of a plurality of segmental grooves on the periphery of the tubular body provide liquid communication with the longitudinally extending grooves. The grooves of the one row are longitudinally offset from the grooves of the other row.
U.S. Pat. No. 3,407,817 (Galleher, Jr.) discloses a catheter comprising a tube of elongated configuration adapted to be inserted in a body passageway and having a main bore opening through the end of the tube. A through passage extending longitudinally within the wall of the tube is provided having plug means inserted adjacent one end of the tube to seal the passage. An inflatable cuff encircles the tube at a position near the one end of the tube. The tube passage has communication through the wall of the tube adjacent the plug means with the interior of the inflatable cuff. Cuff inflation means is inserted in the passage near the opposite end of the tube. The inflating means has a pressure release opening. A resilient means is removably secured over the opening. The resilient means in the scaling relation indicates the extent to which the cuff is inflated in response to fluid pressure from the inflating means. The resilient means when removed from the scaling relation simultaneously deflates itself and the cuff.
U.S. Pat. No. 3,590,820 (Nehru) discloses a hollow cylindrical aspirator tip that has radially passages that communicated hollow cylindrical tip with the outer ends of the longitudinal extending slot passages. Specifically, Nehru discloses an aspirator tip comprising a hollow cylindrical member having one closed end. Radially extending primary passages are provided through the aspirator tip adjacent the closed end. Means operably associated with the primary passages for relieving vacuum drawn in the primary passages to prevent damage to mucous membrane in contact with the aspirator tip over the outer end of the primary passages there through on drawing a vacuum through the tip are also included. Longitudinally extending relief passages in the tip communicating are included with the primary passages. Longitudinally extending slots between the exterior surfaces of the tip and the relief passages in the tip are also included to permit drawing of fluid through the slots into the relief passages and subsequently into the interior tip through the primary passages. This type of drain is limited in use and is specifically designed to remove blood and secretion during a surgical incision, whereby the tip is connected to a high vacuum source.
U.S. Pat. No. 3,599,641 (Sheridan) discloses a multilumen catheter having a proximal end, a distal end adapted for insertion in the body of a patient, and a principal channel connecting the distal end with the proximal end for transport of fluid. A secondary channel of smaller size than the principal channel is provided, An opening through the sidewall of the catheter adjacent the proximal end provides fluid flow across to the secondary channel and a connector tube of smaller outside diameter than the catheter fixed at one end to the opening. A combination connector channel closure system for the catheter comprises a first connector member having an enlarged central body portion. A male connector portion on one end and a female portion at the opposite end into which the proximal end of the catheter fixed is also provided. A second connector member of similar configuration to the first connector member is fixed at the female portion to the free end of the connector tube. A short section of flexible plastic tubing is fitted at one end over the male connector portion of the first connector member and is fitted at the other end over the male connector portion of the second connector member. The combination of short tubing and connector members forms a resealable seal against entrance of material into the catheter and the connector tube.
U.S. Pat. No. 3,630,206 (Gingold) discloses a bladder catheter for males having an elongated flexible core element having first and second end portions and an outer surface provided with one or more grooves extending along the core element at the first end portion of the core element for being received and retained within the bladder of a subject to be treated. A flexible tubular member within an opening is slidably received about the core element. After the element with its tubular member about it are inserted into the urethra of the subject with the first end portion of the core element received and retained within the bladder, the tubular member is partially withdrawn from about the core element to an extent allowing the urethra to be flushed by the draining urine while still remaining in position over the second end portion of core element to receive the urine into the tubular member for external disposal. This type of drain is limited in use and is specifically designed to flush the urethra, is not for use in post-surgical drainage, and is always exposed to infection.
U.S. Pat. No. 3,860,008 (Miner et al.) discloses a surgical drain comprising a series of rods lying on two horizontal planes. The rods of one plane are staggered in relation to the rods on the other plane. The rods on the same plane are in spaced relation to each other and the rods on the plane are connected to adjacent rods on the other plane by a web. The drain is adapted to be torn along a web on a line substantially parallel to a rod and adjacent rods are in acute angular relation to each other. This type of drain has a limit of use and is specifically design to the atmosphere, rather than to an outflow tube and being exposed to infection.
U.S. Pat. No. 4,398,910 (Blake et al.) discloses a wound drain catheter for draining fluid form, or supplying medication to, a closed, deep wound having a drain. The drain comprises a core portion having a longitudinal axis. Plural strut portions are provided extending outwardly from the core portion. Overhang portions, connected to the outward ends of the strut portions, respectively, cooperate with the strut portions to form longitudinal lumens. The overhang portions cooperate with each other to form, on the outer surface of the drain, the segments of a segmented, closed curve. The gaps between the segments provide plural longitudinal grooves for fluid communication between the wound and a respective one of the plural lumens. The grooves are sized to inhibit tissue from growing and debris from passing through. The drain is formed of a material which, when placed in tension between the gripping wound tissue and a force used to withdraw the drain from the wound, will reduce sufficiently in cross section to reduce the gripping force to facilitate withdrawal. The drain has a substantially uniform cross section throughout the portion of its length which is placed in tension during such removal to provide means for reducing stress risers and thus preventing breakage. A flexible outflow tube has a smooth exterior for sealing to surface tissue at the point of exit from a patient's body. Means conforming to the segmented, closed curve, for connecting the outflow tube to the drain are also provided.
U.S. Pat. No. 4,445,897 (Ekbladh et al.) discloses a catheter for post surgical drainage of a wound comprising a flexible tube having a distil end and a proximal end. The catheter has a centrally arranged inner lumen that extends longitudinally. The catheter is adapted to be connected at its proximal end to a suction means for withdrawing drainage through the lumen and is adapted for its distal end to be implanted in the wound area to be drained. In the catheter, there is provided at least one longitudinal slot opening in the surface of the distal end of the catheter which connects to a second longitudinal lumen which is at least as long as the slot opening and has a maximum width which is larger than the width of the slot opening. There is further a plurality of through openings extending between the base of the second lumen into the first lumen, whereby drainage can pass from the wound area to the second lumen then into the first lumen.
U.S. Pat. No. 4,465,481 (Blake) discloses an elongate catheter of one piece construction for draining fluid from or supplying fluid to an environment comprising a drain segment of substantially constant cross section throughout its length having plural elongate fluid openings in the form of grooves extending throughout the length of the sidewall. The openings are spaced circumferentially from one another. A second transition segment is provided with closed sidewalls in fluid communication with the elongate openings of the drain segment having an perimeter size, in cross section, substantially the same as that of the drain segment, but having an interior cross section different from that of the drain segment.
U.S. Pat. No. 5,549,579 (Batdorf et al.) discloses a drainage tube having a proximal end and a distal end including an implantable portion adapted for implantation beneath the skin of a patient. The implantable portion has a length and comprising in combination: (a) a hollow tubular collecting portion having a first length, a first outer surface and a first inner surface having struts projecting inward therefrom coextensive with the first length, the first outer surface presenting a uniform first cross-sectional profile along the first length and wherein the first cross-sectional profile has a greatest dimension; and (b) a hollow tubular extension portion having a second length and a second outer surface having a substantially uniform second cross-sectional profile coextensive with the second length, the second cross-sectional profile having a greatest dimension which is less than the greatest dimension of the first cross-sectional profile; and (c) a hollow transition portion therebetween, the transition portion providing an integral connection between the proximal end of the collecting portion and the distal end of the extension portion, the transition portion providing a gradual transition between the first cross-sectional profile and the second cross-sectional profile; the improvement wherein the greatest dimension of the first cross-sectional profile and the greatest dimension of the second cross-sectional profile of the implantable portion of the drainage tube progressively decreases along the length of the implantable portion in the direction of the proximal end of the drain, and wherein the implantable portion is of unitary construction.
U.S. Pat. No. 6,099,513 (Spehalski) discloses a wound drain device for implantation into and for drainage of fluid from a wound of a patient. The device comprises an elongated annular outer wall defining an exterior surface. An elongated central core defining at least one longitudinal axis is provided and is disposed within and spaced radially inwardly from the outer wall. A plurality of elongated radial inner walls is disposed within the outer wall and extends along, outwardly from, and circumferentially spaced about the longitudinal axis. The inner walls further extend between and connect to the central core and the outer wall such that the inner walls together with the outer wall form a plurality of elongated enclosed lumens for draining fluids from the wound. The lumens circumferentially are spaced from one another about and extend along the longitudinal axis such that the inner walls are disposed between the lumens. Each of the inner walls has an elongated open duct defined and extend along the longitudinal axis such that each of the ducts is in a respective one of the inner walls disposed between the lumens. Each of the ducts is formed by an interior base surface defined in the respective one inner wall adjacent to the central core and by a pair of opposing interior side surfaces defined in the respective one inner wall so as to extend from the interior base surface to the exterior surface of the outer wall and define an elongated entrance to the duct through the outer wall to permit fluid flow from the wound exteriorly of the outer wall through the entrance and into the duct. Each of the ducts has a maximum width between the opposing interior side surfaces which is substantially smaller than a maximum width of each of the lumens between the inner walls. This type of drain has limited use and is specifically design to the atmosphere, rather than to an outflow tube and always exposed to infection causing organism. This type of drain can be easily clogged in the entrance passage area and is closed the drain communication at the entirely lumen (slot) length.
Prior art wound drain catheter systems typically suffer from one or more problems. The systems may be rigid, bulky, difficult to use, have limited use, have permanent attachments, and may not eliminate the risk of infection. Optimally, the drains should be brought out through an incision in healthy tissue and not through an incision in the wound. A drain tract coming through the suture line increases the risk of infection and is a potential source of weakness that may lead to ventral hernia. Percutaneous catheter drainage is recommended for all postoperative trauma patients. The drains are generally anchored to the skin with a nonabsorbable suture and the use of sterile safety pins prevent retraction of the drains into the wound. At present, catheters are fastened in position either by suturing the catheter to the skin or by using adhesive tape. Adhesive tape tends to become wet as a result of the discharge of body fluids and thus loses adhesion. Sutures can be inadvertently placed around or through drains causing the drains to break off inside the body. Accordingly, there is a need for an improved method of introducing a percutaneous wound catheter.